Quiz 3 Study Guide answered
docx
keyboard_arrow_up
School
Johnson County Community College *
*We aren’t endorsed by this school
Course
HCIS-271
Subject
Medicine
Date
Jan 9, 2024
Type
docx
Pages
4
Uploaded by CaptainGrouse3157
Understand and be able to explain what it Evidence Based Medicine (EBM).
•
A set of tools and disciplined approach to informing clinical decision-making
–
Applies the best evidence available
–
Though cannot forget the caveat: “Absence of evidence is not evidence of
absence” (Carl Sagan)
Allows clinical experience
•
(art) to be integrated with best clinical science
•
Makes medical literature more clinically applicable and relevant
Know what duties a nurse might perform.
Nurses fill a wide range of roles within healthcare, but usually they focus on caring for patients
and teaching others about health issues. Many nurses provide direct patient care. Depending on
their training and expertise, nurses might assist a patient with personal care, such as with
dressing or bathing; provide care for a health problem, such as changing the dressing on a
patient’s wound; screen a patient for diseases; assist doctors with procedures; or give a patient
medication. Some highly trained nurses, such as nurse practitioners, may even write
prescriptions depending on the scope of state licensure. The degree of direct patient care that
nurses provide varies according to their job position and the provider type.
Understand summarizing evidence: What is it? How are the studies used? How do the studies
interact?
The idea behind summarizing evidence is that for many tests and treatments, there are multiple
studies, such that one study does not tell the whole story.
One study may contradict others, or
studies may complement each other and build up to make a much stronger case.
For this
reason, there has been a growing trend towards what are called systematic reviews or evidence
reports that aim to bring all the evidence on a given test or treatment together.
Remember the
Haynes 4S model – it had studies at its foundation, then had syntheses and synopses that
brought the data together and made it available to users, particularly clinicians, in a highly
digested form.
Summarizing the evidence is not just going out and collecting a few studies and
bringing them together.
There are methodologic challenges in summarizing the evidence. Such
challenges were recently elucidated in a supplement to the journal, Annals of Internal Medicine,
making one realize the methodology that is required to do summarization of evidence.
The application of summary statistics relies on two particular statistics, each of which
measures different events. What is the purpose of each of those statistics?
the odds ratio is used for binary events.
Many studies are reported in terms of how they reduce
certain events that we are trying to avoid, such as death, certain complications of a disease, the
development of a myocardial infarction, or someone who has high blood pressure, or the
development of kidney disease, or someone who has diabetes, or a recurrence of a disease, or
the re-emergence of cancer that might occur after initial treatment.
Usually the odds ratio
statistic is configured when it is less than one, which indicates there is a benefit for treatment.
This is the approach, for example, that the Cochrane Collaboration uses – which we will talk
about later in this lecture.
When the odds ratio is less than one, then there is benefit for the
treatment and it turns out, when the confidence interval does not include the odds ratio equals
1 line, when it does not cross over that line, our results are statically significant.
We can
calculate in a somewhat complicated formula, the number needed to treat from the odds ratios,
so we can translate odds ratio findings into something that have a little more meaning from a
practical standpoint.
The other summary statistic is weighted mean difference.
This statistic is used for numeric
events such as measurements, such as blood pressure value or blood sugar value. The weighted
mean difference is usually configured such that a value less than zero indicates that there is a
treatment benefit, and a value of greater than zero indicates that there is benefit for the control
intervention.
Just as an odds ratio value of greater than one indicates that the control is of
more benefit.
Again, if the confidence interval crosses over the weighted mean difference
equals zero line, or if it does not cross over that line, it means that the results are statistically
significant.
What is required for an effective screening test?
–
Low cost
–
Intervention effective – ideally shown in randomized controlled trial
–
High sensitivity – do not want to miss any cases; usually follow up with test of
high specificity.
Understand and know the legal obligations concerning nurses to their patients when
administering medications. What are the patient rights?
Nurses also need to adequately document all the care that they give to a patient. This
documentation creates a legal record, so it needs to be clear, objective, and thorough.
Medication errors cause hundreds of thousands of deaths and injuries in the United States
every year, and nurses and their employers can be held liable. Nurses are expected to give the
right drug to the right patient, at the right dose, at the right time, and by the right route.
If a patient shares that he or she, or that someone else, was abused, nurses are legally obligated
to report this information to the appropriate authorities. For example, a patient might make an
allegation of domestic abuse, child abuse, or sexual abuse.
What are clinical practice guidelines?
It is basically a series of steps, sometimes called an algorithm, that walk us through the
provision of clinical care, either the work-up to reach a diagnosis or the steps of the treatment.
Clinical practice guidelines can be provided in a number of ways.
Sometimes they can be
provided in a textual format or in tables that list what should be done in certain conditions.
Often times, they will be presented as an algorithm
.
Algorithms have different types of steps.
There are action steps, where we perform a specific
action.
There are conditional steps, where we carry out an action based on some criterion.
There are branch steps, where flow may be directed to one or more other steps. Finally, there is
synchronization, where we come back from the branch steps to a single point.
What are the types of foreground questions and what are they used to answer?
Foreground questions are when we ask for knowledge about managing patients with specific
disorders and were contemplating a test or a treatment - these are the questions that are
usually answered with evidence based medicine techniques.
•
Have three or four essential components (PICO)
–
Patient and/or problem
–
Intervention
–
Comparison intervention (if appropriate)
–
Outcomes
What does an ambulatory nurse do?
Ambulatory care nurses care for patients with non-urgent problems, usually over multiple visits.
They treat and educate patients about a wide range of medical problems, with the goal of
improving the patient’s long-term health. Many ambulatory care nurses also use
telecommunications tools to provide long-distance care, monitoring, and medical advice.
What is a synopsis in the hierarchy of evidence?
•
Synopses – highly summarized information appropriate for clinical setting, e.g.,
–
Critically appraised topics (CATs)
–
Clinical Evidence
, InfoPOEMS, PIER
–
Clinical practice guidelines
Which type of nurse has the least amount of education?
LPNs
Understand the purpose of a screening test/exam: What is primary and secondary
prevention? Be able to give an example of screening exams.
aim to keep the disease or its complications from occurring, sometimes called primary
prevention. Or we may want to prevent complications from developing when the disease has
already happened, sometimes called secondary prevention.
A pap smear is an example of a screening exam.
What ways does technology assist the nurse with the prevention of medication errors?
Technological solutions include using bar-coding technology on medication and using a
computer program to report when medications are given late.
Be able to define and explain:
-Randomized controlled trial:
provide the best evidence for harm but often it cannot be
done or it would be unethical to do so.
Therefore, we have to use lesser forms of evidence.
-Cohort study
:
can help us in a situation where these poor outcomes are rare.
Of
course, cohort studies are problematic when the groups are not really similar.
For example, if
we follow a cohort of people and we compare those who take the NSAID drugs and those who
do not, they are obviously different people.
Those who take the NSAID drugs are more likely to
have ongoing medical problems, particularly those that require these drugs, so we do not get
that benefit of randomization.
-Case control study:
the most common form of observational study and it is the most
common type of study done to assess harm.
There are times when we suspect that something
is harmful and we want to find out as quickly as possible. We cannot do a prospective study
because it might take years to get results, so we look retrospectively.
We identify cases of the
disease that we think are caused by the harmful agent, and then we match them to controls,
thus the name, case-control study. Then we look at the two groups, those who have the cases
and those who are the controls, and we see if there is a different rate or amount of exposure.
-Case series/report:
The lowest form of evidence is the case series, or even worse, the
single case report.
Of course, the reason why this is the lowest form of evidence is there is no
comparison group.
A case series can be used to generate a hypothesis that could then be
Your preview ends here
Eager to read complete document? Join bartleby learn and gain access to the full version
- Access to all documents
- Unlimited textbook solutions
- 24/7 expert homework help
tested with more rigorous study designs, but a case series or case report, in and of itself, is not
considered to be high quality evidence.